Sagecare (Southwark)

Updated 22 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was carried out by two inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of service.

Service and service type

Sagecare Southwark is a domiciliary care agency. It provides personal care to people living in their own homes.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. Senior staff told us they had recently recruited a new registered manager.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because we needed to ensure they would be available to assist us with the inspection. Inspection activity started on 07 December and ended on 13 January. We made calls to people and their relatives between 13 December and 14 December 2022.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received about the service since the last inspection. We used all of this information to plan our inspection.

During the inspection

We reviewed a range of records related to 13 people’s care and support. This included people’s care plans, risk assessments and medicine records. We reviewed three staff files in relation to recruitment and training. We reviewed records related to the management of the service, which included safeguarding incidents, accidents and incidents, complaints, audits and a range of policies and procedures.

We also reviewed electronic call monitoring (ECM) data for 227 people for the month of October 2022. An ECM system is an electronic system where care workers log in and out of their calls, and the information is recorded.

We spoke with six staff members. This included the branch manager and the area manager. We also asked the manager to share a questionnaire with all active care workers to give them an opportunity to give us feedback about their experience of working for the service. We received feedback from 35 care workers.

We contacted 25 people and we spoke with 15 people and 9 relatives. We contacted five health and social care professionals, but we received no feedback.

We continued to seek clarification from the provider to validate evidence found. We looked at four people’s care plans medicine records a training matrix, quality assurance records and a range of care plans.

Updated 22 February 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Sagecare (Southwark) Limited is a domiciliary care agency registered to provide personal care to people living in their own homes. The service provides support to a wide section of the community, people living with dementia, older people, people with physical disability, learning disability, younger adults, mental health and sensory impairment. All of these people resided in the London Borough of Southwark. At the time of the inspection 227 people were being supported with personal care.

Not everyone who used the service received personal care. The CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Right Support: The provider was not following the principles of the Mental Capacity Act. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The provider was unable to provide any evidence where decisions were made in people's best interest and where people may lack capacity.

People were not always notified when care workers were running late. We made a recommendation to the provider to review their practices to ensure people received their calls in line with their agreed care plan.

People told us the care workers were kind and caring. People told us that their dignity, and privacy was maintained.

Right Care: Medicines were managed safely. Risk assessments were in place to guide care workers on how to care for people safely. There were appropriate processes for the recruitment of care workers. The provider had effective processes in place to safeguard people from the risk of harm.

People were assessed prior to care packages starting. People’s nutritional needs were recorded however at times guidance was generic for care workers to follow.

The provider was migrating all care plans to a new electronic system, and we found people’s nutritional and hydrational plans were at times generic. We made a recommendation for the provider to ensure care plans were personalised. Care workers received an induction before they started delivering care and support. People told us that care workers had the necessary skills to carry out their role.

Right Culture: The quality assurance and governance processes in place needed to be strengthened as they had not addressed issues, we found with the care people received. The service was without a registered manager and people and care workers felt the service was not always well managed. Care workers spoke about a culture of favouritism and people felt communication needed to be improved to ensure people received their care safely.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for the service was good (published 20 September 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to the need for consent and good governance. We made three recommendations to the provider. We asked the provider to ensure their systems were robust to ensure people received their care calls on time. We recommended that the provider ensure all care plans were personalised and to ensure the complaints policy is followed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.